RE: Pt. Scenario

["Paul M. Wright, Jr." <pmwright@home.com>]

I don't think it's all that simple.  The legal standard is "local standard of care" with the keyword being "local".  To the best of my knowledge, there is no nationwide "standard" with force of law that dictates that a particular patient with a particular indication must always be transported to a Level I Trauma Center (if there even is one in the region).  It is in the best interests of a community and its EMS people to have defined their own local policies and my experience has been that both judges and juries generally find those policies reasonable if they are based on medical selection criteria and show evidence of thought and reflection.

 

Where EMS providers incur risk is in an instant where they deviate from those policies without good reason or use criteria other than medical condition.  For example, one case in our area resulted from an auto accident with two seriously injured patients, one more so than the other.  The less seriously injured patient who "appeared to have money" was sent by air to one trauma center while the more severely injured patient who "appeared to have no money (based on vehicle and race)" was transported by ground to a more distant facility.  The plaintiffs allege that the EMS crew utilized racial and/or financial profiling rather than strict medical criteria to make the decision.  If true, that's a problem and one worthy of litigation.

 

I would also note that Level I Trauma Centers are limited in their ability to handle multiple patients, so there are, in fact, times when a patient may receive definitive care sooner at another facility and I seriously doubt that a judge or jury with full view of the facts would have a problem with an EMS crew sending a patient to another facility under those circumstances.

 

When I first became a paramedic, there was considerable debate as to whether paramedics should be trained to simply follow directions ("cookbook style") or whether they should be trained to be capable of independent thought.  I was fortunate that the system in which I worked had relatively unreliable communications links so we followed the latter model.  The legal advice I received at the time was to always make decisions for the patient's best interests and document not only my findings but my thoughts so that I could re-create the scenario in a deposition or trial.   I've had to do that several times (thankfully, always as a witness, never as a defendant) and that strategy has served me well even when things went wrong in some way and litigation resulted.

 

Finally, I would note that the biggest damages in EMS lawsuits have been awarded in cases where the plaintiffs' attorneys were able to paint the defendents as uncaring, abrasive, arrogant and rude.  Lawsuits don't typically happen when honest mistakes and misjudgements are made by caring, involved healthcare givers;  they typically happen when people feel betrayed, lied-to, discriminated against or otherwise made to feel that they've been ripped off or deprived of some opportunity that should have been available to them.  The system is not perfect and I know some clinicians who have been unfairly punished by it but even formal studies have shown that clinicians with a good bedside manner get sued far less often than their socially dysfunctional colleagues.

 

I've resisted making a judgement on the scenario that started this thread because I simply didn't have enough facts and as the subsequent discussion has suggested, there might very well *not* be a correct answer that fits every similar circumstance.  The best general guidance might be nothing more than a clinical application of the Golden Rule.

 

 

regards!

 

paul

 

 

Paul M. Wright, Jr.

Mesa, AZ

 

 

 

 

 

-----Original Message-----
From: flightmed-admin@flightweb.com [mailto:flightmed-admin@flightweb.com]On Behalf Of Fltrt@aol.com
Sent: Friday, January 04, 2002 1:37 PM
To: flightmed@flightweb.com
Subject: Re: Pt. Scenario

I understand the argument that "community hospitals" (less that level one TC's) have great people, many of whom may have worked at level one TC's themselves in the past. I also understand that there are level one TC's that may not always live up to  expectations all of the time. We must keep in mind in a court of law you will not be able to defend yourself with anecdotal ideas as to who may or may not meet certain expectations. If they have an identifier as level one TC and that is what the standard requires for the patient, than that is the standard you will be held to.
Mike H.